# Citizens’ feedback on health service and the responses of health authorities of Bangladesh: An analysis of the Grievance Redress System

## TL;DR

This study examines how Bangladesh's health authorities respond to public feedback through a grievance system, finding that while responses are generally quick, serious complaints are less likely to be resolved.

## Contribution

The study provides empirical evidence on the effectiveness of Bangladesh's Grievance Redress System in handling health service feedback.

## Key findings

- Complaints made up 60% of feedback, focusing on workforce behavior and infrastructure.
- Serious complaints were significantly less likely to be resolved compared to minor ones.
- The median response time was 3.48 hours, with most cases being forwarded to relevant departments.

## Abstract

Developing nations like Bangladesh face unique challenges in healthcare delivery system due to resource constraints, making it crucial to assess the responsiveness of healthcare authorities to citizen feedback. This study utilized data from the Ministry of Health and Family Welfare’s (MOHFW) Grievance Redress System (GRS) in Bangladesh, collected from January 1st to August 8th, 2023. A total of 11,604 anonymous messages received from health service takers were retrieved and analyzed. Kaplan-Meier analysis, and log-rank tests were conducted to assess feedback response times. Feedback were mainly complaints (60.33%), followed by compliments (22.03%) and suggestions (14.48%). Complaints were primarily related to the health workforce, infrastructure, and service utilization. Responses included forwarding (67.02%) to the relevant department, closure (30.12%), resolution (2.55%), pending (0.05%), and overdue (0.25%). The median response time was 3.48 hours (IQR: 1.26 – 13.00). Kaplan-Meier analysis revealed that moderate and major complaints were significantly less likely to be resolved than minor complaints (p < 0.001). The status and responsiveness of the grievance redress process of the healthcare delivery system in Bangladesh highlighted in this study can be used to plan the enhancement of the redress system and, thereby, improve health service.

Bangladesh faces significant challenges in delivering equitable healthcare due to limited resources. To understand how effectively the system addresses public concerns, we analyzed 11,604 anonymous messages submitted between January 1 and August 8, 2023—through the Ministry of Health and Family Welfare’s innovative Grievance Redress System (GRS). Messages fell into three categories: complaints (60%), compliments (22%), and suggestions (14%). Complaints most often concerned workforce behavior, facility infrastructure, and barriers to accessing services. We found that health authorities responded promptly, with a median response time of 3.5 hours, typically forwarding issues to relevant departments (67%), closing cases (30%), or resolving a small number (2.6%). However, serious complaints were significantly less likely to be fully resolved by the GRS authorities compared to minor ones. Our findings highlight both the responsiveness and the limitations of Bangladesh’s grievance system. Strengthening this feedback mechanism—particularly for addressing more serious complaints—could enhance trust in public health services and contribute to improved health outcomes.